SOAR’s goal is to reduce preventable harm by helping Colorado hospitals reach and stay at or below the Healthy People 2030 goal for cesarean deliveries among first-time, low-risk births (known in clinical reporting as the NTSV rate): 23.6% or lower. 

What is SOAR?

The Colorado Perinatal Care Quality Collaborative’s Supporting Vaginal Deliveries for Low-Risk Mothers (SOAR) initiative works with Colorado hospitals to reduce unnecessary first-time cesarean deliveries among low-risk mothers, technically known as NTSV (nulliparous, term, singleton, vertex) births. SOAR is based on an Alliance for Innovation on Maternal Health (AIM) Patient Safety Bundle. Since 2018, SOAR has supported Colorado hospitals with clinical tools, data feedback, and quality improvement coaching aimed at the Healthy People 2030 national target: no more than 23.6% of these births ending in cesarean delivery.

A new evaluation, conducted in partnership with Ariadne Labs, looked at nine years of data (2017–2025) across 51 Colorado hospitals, 32 that participated in SOAR at some point, and 19 that never enrolled, to see where things stand.

SOAR’s approach to supporting hospitals has changed along the way. From 2018 through 2023, hospitals could join or leave at any time, and those with higher cesarean rates were especially encouraged to participate. Starting in 2024, the program became more structured: hospitals now enroll together each January and receive more frequent coaching and check-ins. Because of this shift, the evaluation looked at five separate groups of hospitals based on when they joined, from the earliest adopters in 2018 through hospitals that joined during the COVID-19 pandemic, a larger wave in 2022–2023, and two newer groups under the current model in 2024 and 2025, rather than combining everyone into one group.

What we found

On average, hospitals participating in SOAR are delivering cesareans at rates at or below the state’s target: 21.1%, down from 23.3% before they joined the program. Every group of SOAR hospitals, regardless of when they joined, now averages below the Healthy People 2030 23.6% goal.

Over the same stretch, hospitals that never joined SOAR moved the other way, from 21.8% in 2017 up to 25.6% in 2025, above the national target.

The evaluation found no evidence that SOAR increased or decreased healthcare costs. Researchers tested this two ways, with a simple before-and-after comparison and a more rigorous statistical method, and neither found a reliable cost difference tied to SOAR participation.

That said, costs rose sharply for SOAR and non-SOAR hospitals alike. For hospitals that never joined SOAR, typical quarterly costs tied to these cesarean deliveries (combined costs for the mother and baby, not hospital-wide costs for all births) grew roughly five-fold between 2017 and 2025, and SOAR hospitals saw a similar rise. This rise is far steeper than ordinary healthcare cost inflation would explain, and the evaluation can’t fully explain what’s driving the extreme cost increase.

What we don’t know yet

Due to the limitations of this evaluation, including the small number of hospitals in each group studied and the short follow-up period for the newest program model, it can’t yet tell us whether SOAR itself caused the improvement among participating hospitals. The hospitals that joined SOAR differ from those that didn’t: they are generally larger and more often in urban areas, so some of the gap between the two groups may reflect differences that existed before SOAR began, not the program’s effect.

When researchers used statistical methods designed to isolate SOAR’s effect from other trends, the improvement did not reach the standard threshold for statistical confidence in most hospital groups. In plain terms: the direction of change is encouraging and consistent with SOAR’s goals, but we can’t yet say with statistical certainty that SOAR caused it, rather than other factors already at play.

What’s next

Since 2024, SOAR has shifted to a more standardized, consistent model for hospital engagement, and the evaluation team recommends tracking this newer, more uniform group of hospitals for another year or two to get a clearer answer on both the impact on clinical outcomes and associated cost of care. Future work could also look at newborn health outcomes and the costs of repeat cesarean deliveries that could potentially be prevented.

We are encouraged that the initial takeaway is this: hospitals working with SOAR are meeting Colorado’s clinical goal for cesarean rates among low-risk birthing people, and the trend is moving in the right direction.